Study of recent trends in acute pancreatitis.

Background: Acute pancreatitis is an acute condition presenting with abdominal pain and usually associated with raise pancreatic enzyme level in the blood or urine as a result of inflammatory disease of pancreas. Pancreatitis is a disease of wide clinical variation ranging from mild discomfort alone to a severe illness with hypotension, metabolic derangement, sepsis, multiple organ failure and death. Mortality from acute pancreatitis has decreased from around 12 to 2 percent, according to a large epidemiologic study of acute pancreatitis. However, mortality rates remain much higher in subgroups of patients with severe disease. Aims & Objective: To study recent trends in acute pancreatitis, to study the various etiological factors for development of acute pancreatitis, assessment of various clinical features, complication, investigations and diagnosis of acute pancreatitis and its complications, to evaluate various modalities of the treatment for acute pancreatitis and its complications. Material and Methods: Material of this study consists of 50 patients of acute pancreatitis who were admitted in our Hospital. The clinical presentation clinical examination was carried out, and physical findings, associated medical conditions, laboratory and radiological investigations, severity, management and outcome were studied and the etiology was determined by reviewing the medical records of all cases documented to have acute pancreatitis during the period of study. Results: Average hospital stay for 50 patients in our study is approximately 7 days. The diagnosis of acute pancreatitis was considered when abdominal pain is associated with elevation of serum amylase level. Abdominal pain (100%), fever (82%), vomiting (86%), abdominal distension (40%) and dyspnoea (50%) are its common clinical symptoms. Conclusion: Gallstones and alcohol abuse are the main causes of acute pancreatitis. There is no mortality in our study. Among all the patients, only 4 patients in the follow-up developed complications approximately after 2 months of duration of attack; and they undergone for operation. Clinical examination, serum amylase and ultrasonography are still the diagnostic tool for pancreatitis. Most cases of pancreatitis can be managed conservatively with early diagnosis, aggressive medical management and by treatment of cause.

A study of accuracy of triple assessment as a clinical tool for the diagnosis of a palpable breast lump.

Background: Diseases related to breast are the highest in this country as well as in the world. Various types of lesion from inflammation to carcinoma can affect breast. Some lesions are common in young females while others in elderly age group. Early presentation and prompt diagnosis is essential to relieve anxiety of non-neoplastic conditions, and in case of carcinoma, it can save the patient from metastases. In this study many cases related to breast lesions from the region are reported in the surgery clinics of this institute and various breast diseases are being managed in the clinical departments. For disease confirmation, many diagnostic procedures are recommended with aims to help in decision for surgical treatment. To study prevalence of various breast disease condition coming to our hospital and their management. Analysis of pattern and prevalence will be a valuable guideline for clinicians of this location to compare with that of others. This study was to evaluate the accuracy of Triple assessment (physical examination, mammography and fine needle aspiration cytology) as a clinical tool for the diagnosis of a palpable breast lump. Aims & Objective: (1) To study incidence for breast disease; (2) To study etiopathogenesis of it; (3) To study patient presentation and manifestation; (4) To study management of various breast diseases; and (5) To study various modalities of treatment. Material and Methods: This prospective study was carried out in the department of surgery during period from 1st march 2011 to 28th February 2012 in indoor and outdoor patients. Each patient was study in detail with relevant clinical history, examination, mammography and histological findings and management. The study comprised of total 100 patients of breast disease treated with various modalities. Results: In the study of total 100 cases, inflammatory conditions were present in 15%, fibrocystic lesion 35%, fibroadenoma 20%, gynaecomastia 2% and carcinoma 10%. This comparative study reported data by clinical analyses, mammography and histological findings in 100 women with ages from 18 to 60. Malignant carcinoma found in 10% of cases while benign breast disease and other condition found in 90% of cases. Conclusion: Fibrocystic disease was the commonest lesion in this study with 30 years as the average age of presentation. Malignancy was detected above 47 years of age. Ninety patients with breast lumps interpreted by Triple Assessment as benign correlated with the histopathological findings whereas of 10 malignant lumps. This gives Triple Assessment an overall accuracy of 100% in our study.

Comparison of percutaneous ultrasound guided needed aspiration and open surgical drainage in management of puerperal breast abscess.

, less morbidity and will allow the patient to carry on breast feeding. Aims & Objective: The aim of this study is to compare the management of puerperal breast abscess by percutaneous ultrasound guided needle aspiration versus open surgical drainage with special attention to resolution and complications. Material and Methods: In this interventional study, 70 puerperal breast abscess cases were randomly divided and undergone either percutaneous ultrasound guided niddle aspiration (Group A) or open surgical drainage (Group B) and results were compared. Results: Failure rate for aspiration therapy was17.14% with 06 patients requiring conversion to open surgical drainage after aspiration and were excluded from study. The resolution time was less in aspiration group. Painful and cumbersome daily changes of dressing, mammry fistula in 3 patients with ugly scar were the main drawback of open surgical drainage as compared to aspiration. However, there was high failure rate of aspiration therapy in abscesses presenting later than 5 days (45.83%) and those with >5 cm size (55.55%) on ultrasonography. Conclusion: Percutaneous ultrasound guided needle aspiration has acceptable failure rate and is an effective alternative to open surgical drainage of puerperal breast abscess especially for those present early and of small size.